Stress Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine

2 The Stress Zone  Stress is almost always an emotional reaction to a situation.  Stress impacts your ability to think clearly, respond appropriately and perform at your best.  Your stress level directly impacts how you feel at the end of the day, your health and your relationships.

3 Warning signs Loss of focus and mental clarity Lack of ability to relax and sleep Loss of self esteem Feeling tired and on edge Struggle to motivate yourself and others Loss of focus and mental clarity Lack of ability to relax and sleep Loss of self esteem Feeling tired and on edge Struggle to motivate yourself and others

© 2007 HeartMath LLC

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7 Autonomic Nervous System Parasympathetic Pathway—Brake Low Effort/relaxation Acetylcholine Sympathetic Pathway—Accelerator High Effort Adrenaline

8 Hormonal System Cortisol DHEA

9 Your Emotional Landscape High Arousal High Energy Adrenaline Low Arousal Low Energy Relaxation Stress Zone Stress Free Zone Positive EmotionNegative Emotion

10 High Cortisol:Low DHEA  Accelerated aging (Kerr et al., 1991; Namiki, 1994)  Brain cell death (Kerr et al., 1991; Sapolsky, 1992)  Impaired memory and learning (Kerr et al., 1991; Sapolsky, 1992)  Decreased bone density; increased osteoporosis (Manolagas, 1979)  Reduced muscle mass (Beme, 1993)  Reduced skin growth and regeneration (Beme, 1993)  Impaired immune function (Hiemke, 1994)  Increased blood sugar (DeFeo, 1989)  Increased fat accumulation around waist / hips (Marin, 1992) Chronic stress=excess cortisol=accelerated aging.

11 High Cortisol: Low DHEA  Obesity (Marin 1992)  Diabetes (Nestler 1992)  Hypertension (Shafagoj 1992)  Heart Disease (Barrett-Connor 1986)  Cancer (Bhatavdekar 1994)  Alzheimer’s (Nasman 1995)  HIV-related disease (Wisniewski 1993)

Effects of Chronic Stress  Gastrointestional disorders Peptic ulcer, irritable bowel syndrome  Cardiovascular disorders HTN, migraine headache  Respiratory disorders Asthma  Dermatologic disorders Eczema, acne, psoriasis  Cognitive disorders Low self-efficacy & self-esteem  Emotional disorders Depression, adjustment disorders, acute stress disorder, PTSD

Psychoneuroimmunology Cortisol release can alter immune system activity leading to decreased ability to resist infection

Stress and Wound Healing Dementia caregivers vs. matched controls 3.5 mm punch biopsy on non-dominant forearm Outcome variable: healing time Longer healing time in caregivers 9 days longer than controls Lancet, Kiecolt-Glaser et al., 1995

Chronic Stress & Heart Disease  Stress ↑ catecholamine & corticosteroid release  Chronically high levels can damage the arteries and heart, and promote HTN and atherosclerosis  Maladaptive behaviors associated with stress (smoking, over-eating) are also risk factors for CVD

Prevention  Enhance social support  Improve personal control  Improve organization Time management  Exercise  Prepare for potentially stressful events Preparing individuals for surgery

“Rethinking”  Frame change as a challenge instead of a threat  Don’t worry about things outside of your control  Set realistic goals at home and work  Approach life with an optimistic attitude  Resolve conflicts with other people

Managing Your Stress Response  Progressive muscle relaxation  Breathing techniques  Biofeedback (e.g., HeartMath)  Mindfulness meditation  Yoga

Mindfulness Meditation  The intentional, accepting and non- judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment.”  Often guided by a recording iTunes  Beneficial in anxiety, depression, general stress

21 Heart Rate Variability (HRV) m Volts 2.5 seconds of heart beat data.859 sec..793 sec..726 sec. 70 BPM 76 BPM83 BPM

Changing Heart Rhythms © 2007 HeartMath LLC

23 Neutral Tool  Heart focus  Heart breathing

24 Quick Coherence ® Technique  Heart focus  Heart breathing  Heart feeling

25 The Power of Positive Emotions Increased longevity (Danner et al., 2001) Reduced morbidity (Goldman et al, 1996; Russek & Schwartz, 1997) Increased cognitive flexibility (Ashby et al., 1999) Improved memory (Isen et al., 1978) Improved decision making (Carnevale & Isen, 1986) Increased creativity and innovative problem solving (Isen et al., 1987) Improved job performance & achievement (Wright & Staw, 1994; Staw et al.,1994) Improved clinical problem solving (Estrada et al.,1997)

26  Reduced blood pressure in hypertension (McCraty, 2001)  Increased functional capacity in CHF patients (Luskin, 2002)  Improvements in asthma (Lehrer, 2000)  Increased calmness and well-being (Friedman, 2000)  Increased emotional stability (McCraty, 2001)  Improved cognitive performance (McCraty, 2001) Benefits of Physiological Coherence

References  UCLA Mindfulness Meditation  Institute of HeartMath  iTunes Store Mindful Meditations 27